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Moseley I, Yang EJ, Mathieu RJ, Elco C, Massoud CM. Wells’ syndrome as a presenting sign of COVID-19 in the setting of allergic rhinitis and iron deficiency anemia. JAAD Case Rep 2022; 23:27-30. [PMID: 35261918 PMCID: PMC8890785 DOI: 10.1016/j.jdcr.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Isabelle Moseley
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Correspondence to: Isabelle Moseley, AB, 555 South Water Street Apt 319 Providence, RI 02903.
| | - Eric J. Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Regine J. Mathieu
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher Elco
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy M. Massoud
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Tekin B, Boire N, Shah K, Hanson J, Bridges AG. Viral panniculitis in a patient with disseminated opportunistic Enterovirus infection. J Cutan Pathol 2020; 48:434-438. [PMID: 33277938 DOI: 10.1111/cup.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 02/01/2023]
Abstract
Infection-induced panniculitis has been described in association with a broad range of microorganisms. Among those, viral panniculitis represents a minor category, with only a few anecdotal reports in the literature documenting viral infection in the subcutaneous fat. Herein, we report a woman in her 30s with seropositive rheumatoid arthritis on rituximab and prednisone, who presented with a 6-month history of progressive multisystem manifestations, including unintentional weight loss, fever, fatigue, myopathy, pancreatitis, and sensorineural hearing loss. She had indurated plaques on her thighs characterized by predominantly lobular panniculitis with chronic lymphohistiocytic inflammation. Molecular studies performed at the Centers for Disease Control and Prevention identified evidence of Enterovirus group with the highest identity of Coxsackievirus A9. Enterovirus RNA was also detected in the cerebrospinal fluid and muscle. Based on the findings, a diagnosis of disseminated enteroviral infection in the setting of B-cell depletion was rendered. To the best of our knowledge, this represents the first reported case of viral panniculitis with documentation of Coxsackievirus A9 in the skin. Since rituximab may be used for the treatment of autoimmune dermatological diseases, familiarity of the potential occurrence of severe enteroviral infections in the setting of immunosuppressive treatment is important for dermatopathologists.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Boire
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kabeer Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pathology, St. Mary's Hospital, Madison, Wisconsin, USA
| | - Jennifer Hanson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Dermatology, Vitality Skincare, Austin, Texas, USA
| | - Alina G Bridges
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Dermatopathology, Dermpath Diagnostics/Richfield Laboratory of Dermatopathology, Cincinnati, Ohio, USA
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Watanabe Y, Yamamoto M, Igari S, Yamamoto T. Two cases of wells syndrome with marked swelling in the hands. Indian Dermatol Online J 2020; 11:979-982. [PMID: 33344351 PMCID: PMC7734990 DOI: 10.4103/idoj.idoj_46_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/27/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
Wells syndrome or eosinophilic cellulitis is an idiopathic inflammatory dermatitis characterized by a benign but recurrent evolution. It often causes edematous urticarial plaques on the extremities. Herein, we report two rare cases of Wells syndrome with marked swelling in the hands. Both cases exhibited various clinical features. Case 1 was Wells syndrome with collagen disease-like sclerotic edema in the fingers and annular erythema on the trunk. Case 2 was Wells syndrome with diffuse plate-like hardening of the forearm mimicking cellulitis, which required fasciotomy due to suspected compartment syndrome at the emergency room. Wells syndrome should be included in the differential diagnosis of patients presenting with marked diffuse swelling in the hands.
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